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American Journal of Ophthalmology [journal]
- Sensitivity and Specificity of Spectral Domain Optical Coherence Tomography in Detecting Idiopathic Polypoidal Choroidal Vasculopathy. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Aug 21.
To evaluate the efficacy of spectral-domain optical coherence tomography (SD-OCT) compared to indocyanine green angiography (ICGA) in detecting idiopathic polypoidal choroidal vasculopathy (PCV) and in differentiating between PCV and occult choroidal neovascularization (CNV).Retrospective observational case control study.SD-OCTs of 51 eyes of 44 consecutive patients who presented with one or more pigment epithelial detachments (PEDs) due to either PCV or occult CNV were retrospectively reviewed by a grader masked to the final diagnosis. A qualitative analysis based on the following tomographic findings was performed: sharp PED peak, PED notch, hypo-reflective lumen within hyper-reflective lesions adherent to retinal pigment epithelium. The diagnosis based on SD-OCT alone was compared with the final diagnosis made using ICGA and fluorescein angiography. Sensitivity and specificity were calculated. Patients with classic CNV and central serous chorioretinopathy were excluded.Among 51 eyes of 44 patients, 37 had an ICGA confirmed diagnosis of PCV and 14 had occult CNV. SD-OCT based on the features above detected 35/37 true positive PCV lesions but missed 2 ICGA confirmed lesions (false negatives). SD-OCT correctly excluded 13/14 non-PCV lesions but misidentified one PCV lesion (false positive). These data showed a sensitivity of 94.6% and a specificity of 92.9% for the above SD-OCT features in identifying PCV lesions.SD-OCT based on the features above allowed for good detection of PCV and differentiation between PCV and occult CNV in this selected clinic population. A careful qualitative analysis of the tomographic findings in patients presenting with PEDs may allow ophthalmologists to distinguish between PCV and occult CNV decreasing the need for ICGA and the risks related to this procedure.
- Endothelial Keratoplasty after Failed Penetrating Keratoplasty: An Alternative to Repeat Penetrating Keratoplasty. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Aug 21.
To analyze graft survival of endothelial keratoplasty (EK) under a previous failed penetrating keratoplasty (PK) compared to repeat PK.Retrospective, comparative cases series METHODS: Consecutive patients who underwent either a repeat PK or EK under PK, after failed PK - whose primary surgical indication was pseudophakic bullous keratopathy at a single tertiary center. Clinical data, donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Study. Main outcome measure was graft survival up to 5 years follow-up.We included a total of 113 eyes that underwent a repeat PK (n=81) or EK under a failed PK (n=32). Cumulative graft survival probabilities comparing repeat PK with EK under PK were at 91.9% versus 96.2% (1 year), 82.6% versus 91.6% (2 year), 66.8% versus 86.4% (3 year) and 51.3% versus 86.4% up to 5 years follow-up respectively (log-rank P value = 0.013). Multivariate Cox regression analysis was performed, which adjusted for: age, gender, risk factors for graft failure (corneal neovascularization, ocular surface disease, glaucoma, active corneal inflammation, anterior synechiae), donor endothelial cell count and repeat donor size. Repeat PK was a significant risk factor for graft failure compared to performing an EK under PK (Hazard ratio: 10.17 95%CI 1.10 to 93.63; p= 0.041).In our study of eyes with bullous keratopathy, endothelial keratoplasty under a previously failed PK provided better graft survival outcomes than repeat PK, adjusting for potential confounders and risk factors for graft failure.
- Dynamic vaulting changes in V4c versus V4 posterior chamber phakic lenses under different lighting conditions. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Aug 18.
To compare vaulting changes in V4c and V4 implantable collamer lens (ICL; STAAR Surgical Company, Monrovia, CA, USA) implanted eyes under different lighting conditions.Non-interventional, cross-sectional comparative observational case series METHODS: Fifty-six eyes of 38 patients implanted with a V4c ICL and 54 eyes of 28 patients implanted with a V4 ICL were enrolled and analyzed. Anterior chamber depth (ACD), pupil size, and postoperative vaulting were evaluated using a Visante optical coherence tomography system (Carl Zeiss Meditec, Jena, Germany) under photopic and mesopic conditions 1 month postoperatively. Refractive errors, keratometry values, axial length, intraocular pressure, anterior chamber volume, and central corneal thickness were also recorded.No significant difference was noted in ACD between photopic and mesopic conditions in either group. Significant decreases in vaulting and pupil size were detected under photopic conditions in both groups. Moreover, vaulting changes in V4c ICL implanted eyes were significantly larger than those in V4 ICL implanted eyes.V4c ICL vaulting decreased more prominently under photopic conditions than V4 ICL vaulting. Therefore, postoperative vaulting under mesopic and photopic conditions should be considered when interpreting the vaulting of V4c ICL implanted eyes.
- Prevalence and risk factors associated with dry eye: The Korea National Health and Nutrition Examination Survey 2010-2011. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Aug 18.
To investigate the prevalence of, and risk factors associated with, "dry eye syndrome" (DES) in South Korea.Cross-sectional study METHODS: In 2010-2011, 11,666 subjects, ranging in age from 19 to 95, were randomly selected as nationally representative participants in the Korea National Health and Nutrition Examination Survey(KNHANES).were divided into a group of clinically diagnosed DES and a group with dry eye symptoms. We determined the prevalence and risk factors of dry eyes in a Korean population. Health-related quality of life(HRQoL), measured with EQ-5D(EuroQoL 5-dimension), was evaluated in patients with dry eyes.The mean age was 49.9 years. The overall prevalence of diagnosed DES was 8.0%(95% confidence interval(CI), 7.3-8.7%), and of dry eye symptoms was 14.4%(95% CI, 13.1-15.7%). Age(adjusted odds ratio(aOR)=1.8, 1.6, female(aOR=2.8, 1.9), history of eye surgery(aOR=2.6, 2.2), stress(aOR=1.7, 1.6), thyroid disease(aOR=1.7, 1.5), and high education level(aOR = 1.6, 1.5) were common risk factors between the groups. Subjects who had undergone ptosis, cataract, or refractive surgery were more likely to have dry eye than subjects with no history of eye surgery. Means of pain and anxiety dimensions in the EQ-5D and EQ-VAS were significantly higher in the diagnosed DES group than in the normal group.The risk factors were mostly similar in both groups. It is thought there will be more patients of DES who have not been diagnosed with doctors. Doctors should identify if a patient has any risk factor affecting dry eye. Patients need to be educated about modifiable factors of DES.
- Postoperative Changes in Amniotic Membrane as a Carrier for Allogeneic Cultured Limbal Epithelial Transplantation. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Aug 15.
To investigate the morphological changes and outcomes of amniotic membrane as a carrier for allogeneic cultivated limbal epithelial transplantation.Prospective, noncomparative, interventional study.A total of 16 eyes receiving allogeneic cultivated limbal epithelial transplantation with amniotic membrane as a carrier were enrolled. Morphological changes of amniotic membrane were observed by confocal microscopy and RTVue-optical coherence tomography. The paired t test was employed to compare the mean best corrected visual acuity (BCVA) and corneal stromal thickness.Twelve eyes had a stable ocular surface (group A), while the other 4 eyes had failed surgeries due to immune rejection (group B). Confocal microscopy showed residual amniotic membrane tissues in 8 eyes in group A at 1 year. However, the amniotic membrane was not detected in group B at 8-10 months. RTVue-optical coherence tomography showed discontinuous amniotic membrane tissues in all eyes in group A at 1 year, while highly reflective opacity was seen in the corneal stroma in group B. There were no statistically differences in mean BCVA and corneal stromal thickness in Group A at 1 month and 1 year after transplantation(P>0.05), but the mean BCVA showed a statistically significant difference at 1 month and after the disappearance of amniotic membrane in Group B (P<0.05).For eyes with a stable ocular surface after cultivated limbal epithelial transplantation, the amniotic membrane can be present in the cornea for at least one year, with no impact on visual acuity and corneal stromal thickness. Chronic inflammation and neovascularization on the ocular surface may accelerate the disappearance of amniotic membrane.
- Reply. [Letter]
- Am J Ophthalmol 2014 Sep; 158(3):646.
- Reply. [Letter]
- Am J Ophthalmol 2014 Sep; 158(3):645.
- Importance of birth weight as a risk factor for severe retinopathy of prematurity when gestational age is 30 or more weeks. [Letter]
- Am J Ophthalmol 2014 Sep; 158(3):645-6.
- Choroidal changes associated with bruch membrane pathology in pseudoxanthoma elasticum. [Letter]
- Am J Ophthalmol 2014 Sep; 158(3):644.